[Long-term results of the conservative treatment of scoliosis using the Chêneau brace]

At present, we survey 52 patients who had been fitted with Chêneau braces in the years 1978 to 1980. The average primary correction of the single curved thoracic, single curved lumbar, and double curved scolioses amounted to 41%. The best late results are to be expected in the single curved thoracic and single curved lumbar scolioses that presented corrections of 14.2% and 9.2%. In the double curved scoliosis we found a correction of 5.5% of the thoracic and 5.6% of the lumbar curves. The Chêneau orthosis was well accepted by the patients. A final valuation, however, will not be possible till some years have passed.

[Final results of the conservative treatment of scoliosis using the Milwaukee brace]

At present, we survey the final results of 62 patients having been treated by a Milwaukee brace. The average curve amounted initially to 35 degrees. There succeeded a primary correction to 32 degrees. At start of weaning the initial angle of 35 degrees was reached again. During the weaning period an evident deterioration of 39 degrees occurred, and at the follow-up control 6 years after the end of weaning the curve was 42 degrees on the average. Thus, our own results are somewhat more unfavourable than those of Mellenkamp et al. In 1977, they reported the results of 47 patients who could be submitted to a follow-up control. The mean scoliotic curve of these 47 patients amounted to 44 degrees at start of treatment, at the last control, on the average 5 years after weaning from the Milwaukee brace, the mean angle was about 40 degrees. Essentially, we could prevent the progression of the curvature, too. If there occurred deteriorations in comparison with the initial angle, they were usually caused by a few patients who developed a drastic deterioration of their scoliosis.

[Results of the treatment of congenital hip dislocation using Salter's open repositioning and pelvic osteotomy]

In this paper the results of Salter's innominate osteotomy combined with an open reduction are shown on the basis of radiographic and clinical investigations. From 1969-1976 43 hips up to the age of 3.11 years had been treated after Salter's method. At the follow-up 65.6% of the hips were found to have normal or slightly pathological AC angles. 63.4% of the hips show good and fair results concerning the ACM angle. The results of the CE angle and the 'hip value' are disappointing: only just 34.1% of the hips can be considered good or fair. This is a consequence of the high rate of preoperative avascular necrosis on the one hand, on the other hand it is based on the fact that most of the cases had had a previous non-operative or operative treatment.

Experimental tracheal and conjunctival infections with Cryptosporidium sp. in pigs

Tracheal and conjunctival infections with Cryptosporidium were established in pigs by inoculation of oocysts into the trachea and onto the conjunctival sacs. The protozoa were found attached to epithelial cells by an electron-dense band and a folded, vacuolated feeder organelle. They were situated in a parasitophorous vacuole surrounded by a double-layered membrane covered by glycocalyx. Trophozoites, schizonts, merozoites, macrogametes and oocysts could be demonstrated. In addition to normal stages of the life-cycle, degenerate stages were found. The infections with Cryptosporidium were characterized by focal destruction and loss of epithelial cells. Numerous intraepithelial lymphocytes were associated with affected foci, as were infiltrations with lymphocytes, monocytes, and macrophages.

Enteric lesions and diarrhea in gnotobiotic calves monoinfected with Cryptosporidium species

The pathogenicity of Cryptosporidium species was studied by inoculation of two gnotobiotic calves with cryptosporidial oocysts that had been decontaminated by treatment with peracetic acid. Two control calves were inoculated with similar material from which the oocysts had been removed by filtration. Oocyst-inoculated animals shed Cryptosporidium in their feces and developed depression, weakness, anorexia, and diarrhea. At necropsy five days after inoculation, endogeneous stages of Cryptosporidium were found in association with epithelial cells throughout the small and large intestines of these animals. The parasites were most numerous in the lower small intestine. Atrophic villi, disordered and degenerate villous epithelium, and hyperplastic crypt epithelium were associated with infection in the small intestine. Control animals remained normal. Extraneous agents were not detected in any of the calves. The results indicate that Cryptosporidium can destroy intestinal epithelial cells and cause diarrhea in monoinfected gnotobiotic calves.

[Results of operative treatment of Scheuermann disease]

Only rarely is a surgical intervention necessary for increased kyphosis in Scheuermann's disease. However, effective erection of fixed kyphoses is only possible with an incision of the anterior spinal ligament, removal of the discs at the vertex of the curvature, resection of the vertebral arch joints, narrowing of the considerably widened vertebral arches and stabilizing with Harrington's instrumentation. The present authors have treated 11 patients in this way. With this procedure it proved possible to erect the kyphosis on average by 53.4%. In the first postoperative year there was an average loss of correction of 1.7 degrees, though subsequent deterioration was only 0.7 degrees up to the time of the last follow-up examination. The residual correction gain was 50.4 per cent. The results in 4 other patients, in whom Schöllner's erector rods were implanted, were less favorable. The permanent correction was only 50.4 in these cases. The best postoperative results are likely to be obtained by a unilateral ventral and dorsal procedure.

Persistent Cryptosporidium infection in congenitally athymic (nude) mice

Nude (nu/nu) BALB/c mice and their white (nu/+) littermates were experimentally infected with Cryptosporidium sp. at 6 days of age. In white mice, the infection was transient, but in nude mice a persistent infection developed that was characterized by diarrhea and, occasionally, death. There were villus atrophy and crypt hyperplasia in the small intestine of infected nude and white mice necropsied at 11 days of age. Persistently infected nude mice had, in addition to the above small intestinal lesions, diffuse cystic mucosal hyperplasia and crypt abscesses in the large intestine at 56 days of age. These results suggest that T cells are required for recovery from the Cryptosporidium infection but are not required for epithelial cell loss in cryptosporidiosis. Both nude and white mice appeared to be relatively more resistant to Cryptosporidium infection at 42 days of age than at 6 days of age.

Right ventricular myxoma

We recently treated a patient with right ventricular myxoma and a clinical picture of pulmonary embolism and tricuspid valve obstruction who had successful removal of the tumor through the tricuspid valve via a right atriotomy.

[On the incidence of thoracal scoliosis in juveniles (author's transl)]

Mass radiography in juveniles between 10 and 19 years of age in Westphalia pointed to a probable incidence of thoracal scoliosis of more than 10 degrees in about 4 per cent of the girls and 1.0--1.5 per cent among boys. In both girls and boys the convexity of the scoliosis is chiefly in the right direction, especially if the apex of the curvature is positioned in cranial direction or if the findings are very pronounced. In a few exceptional cases only the apex of curvature is above Th7. Hence, most of the patients can be adequately treated by means of one of the more recent methods of orthesis.

[Pulmonary vascular pressures and blood gases in young patients with thoracic scoliosis (author's transl)]

Pulmonary artery and pulmonary wedge pressures were measured at rest and during exercise in 25 young patients with moderate to severe scoliosis. Simultaneous determinations of arterial blood gases and pH were performed. The results of the vascular pressure measurements were compared with those obtained in 15 healthy young subjects. In all patients the pulmonary artery and pulmonary wedge pressure were normal at rest. During mild ergometer exercise, however, an abnormal rise in pulmonary artery pressure occurred in 9 patients. Moreover, an increased diastolic pressure gradient across the pulmonary vascular bed was found in some scoliotic patients indicating an elevated pulmonary vascular resistance. It is supposed that this haemodynamic abnormality is primarily due to a restriction of the pulmonary vascular bed. Relationships between pulmonary artery pressure and arterial oxygen tension and blood pH, respectively, could be found. The possible significance of these results is discussed.

[Progress of untreated scoliosis following poliomyelitis up to the end of the growth-period (author's transl)]

Further to an earlier paper on progression of untreated idiopathic scoliosis 37 patients with scoliosis following poliomyelitis are reported on. 16 of them could be observed for 2 years or more having had no treatment. Their progression is clearly more extensive than that of idiopathic scoliosis. But like them it is at a peak during the prepubertal spurt of growth. It also is more obvious the earlier it is recognized. The prognosis of post-poliomyelitic scoliosis is particularly bad when it starts shortly after onset of the paralysis.

[Progression of untreated idiopathic scoliosis up to the end of growth]

110 patients with idiopathic scoliosis are reported on, who had no treatment for 2 years or more before growth stopped. Another 36 patients untreated for 1 year could be observed. The changes in the scoliotic angle were followed up radiologically and entered into a diagram. The average progression of these scolioses during one year were calculated. Progression was always most pronounced between the 10th and 15th year and coincided with the prepubertal increase in growth. This has to be expected 2 years later in boys than in girls. The degree of progression definitely depended on the site of the primary curve. Thoracic and S scoliosis showed most pronounced progression, followed by thoracolumbar and lumbar scoliosis. Progression was worse the earlier scoliosis was diagnosed.